THE EN­EMY WITHIN

AN OLD KILLER IS GAIN­ING NEW GROUND. HERE’ S HOW YOU CAN LEVER­AGE THE LAT­EST SCIENCE TO BOL­STER YOUR DE­FENCE S AGAINST THE FIVE MOST COM­MON CAN­CERS FOR MEN

Men's Health (South Africa) - - CONTENTS - By MARY BRADLEY

An old killer is gain­ing new ground. Lever­age the lat­est science to your ad­van­tage.

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FOR PO­LICE OF­FI­CER MOSES KHESWA , HIS FIRST SIGN OF COL­OREC­TAL CAN­CER AT AGE 46 WAS BLOOD IN THE TOI­LET. FOR RA­DIO AN­NOUNCER MARK PIL­GRIM, DI­AG­NOSED WITH TES­TIC­U­LAR CAN­CER AT 19, IT WAS A SWOLLEN TESTICLE THAT LOOKED OUT OF WHACK. FOR MONTHS, AT 32, BRETT SIMP­SON WROTE OFF HIS SKIN CAN­CER AS A COLD SORE THAT WOULDN’T HEAL . WAYNE HERWITCH, 47-YEAR- OLD SPORTS COACH, HAD NO SYMP­TOMS OF PROSTATE CAN­CER; A ROU­TINE PS A BLOOD TEST ALERTED HIM AND HIS DOC­TOR THAT SOME­THING WAS WRONG, POS­SI­BLY CAN­CER–AND FUR­THER TESTS PROVED IT.

TYPES OF CAN­CER

While there are more than 200 va­ri­eties of can­cer, ac­cord­ing to the Can­cer As­so­ci­a­tion of South Africa (CANSA), the top five among South African men in or­der of fre­quency are skin can­cer; prostate can­cer; col­orec­tal can­cer; lung can­cer; and can­cer of un­known ori­gin. (This last is a grab bag of can­cers that have spread, but doc­tors can’t tell where they orig­i­nated.) But when it comes to younger men – be­tween the ages of 19 and 35, say – tes­tic­u­lar can­cer is num­ber one on the list.

WHAT’S YOUR RISK OF GET­TING CAN­CER?

Ac­cord­ing to the SA Na­tional Can­cer Reg­istry (2012), a man has a one in seven life­time risk for all can­cers.

CAN­CER RISK FAC­TORS

Your chances of get­ting can­cer de­pend on a va­ri­ety of is­sues; in­clud­ing the type of can­cer, your age, fam­ily his­tory and race, and a host of life­style fac­tors – such as whether or not you smoke, drink al­co­hol, con­sume loads of red or pro­cessed meat, avoid fruits and veg­gies, or never get off the couch (let alone crack a sweat).

While we’re on the sub­ject, your weight – if you have too much, and whether it ac­cu­mu­lates around your belly – af­fects the like­li­hood you’ll get cer­tain types of can­cer, in­clud­ing prostate and col­orec­tal.

En­joy­ing the out­doors without ad­e­quate sun pro­tec­tion can set you up for skin can­cers. Un­safe sex or shar­ing nee­dles can in­crease your risk of con­tract­ing viruses

such as HIV, HPV and hep­ati­tis, which in turn leave you vul­ner­a­ble to var­i­ous can­cers, in­clud­ing anal, pe­nile and liver, and Ka­posi’s sar­coma (a type of skin can­cer preva­lent among AIDs suf­fer­ers).

Cape Town gas­troen­terol­o­gist Ed­uan Deetlefs ex­plains: “When it comes to can­cer, there are many ma­jor risks you can’t con­trol, such as fam­ily his­tory and age. But there are oth­ers you can.”

These in­clude your diet, how much and how reg­u­larly you ex­er­cise, and your ex­po­sure to car­cino­gen sources such as smok­ing, al­co­hol, sun, chem­i­cals, and x-rays. Vac­ci­nat­ing against hep­ati­tis and HPV and prac­tis­ing safe sex can also re­duce your risk for cer­tain can­cers.

DIS­BE­LIEF, SHOCK AND FEAR – HOW WOULD YOU RE­ACT?

Most men are not pre­pared for a can­cer di­ag­no­sis. Their ini­tial re­sponse is sur­prise (if not com­plete dis­be­lief), fol­lowed by fear.

Wayne Herwitch – whose part­ner, Lucy Balona, is Head of Mar­ket­ing & Com­mu­ni­ca­tions for CANSA – ex­plains: “You don’t think it’s go­ing to hit you; and when it does, it’s a shock. I had the sense I was just too young to get it.”

De­spite be­ing well-ed­u­cated, health-ori­ented, and hav­ing a wife who is a pro­fes­sional can­cer ed­u­ca­tor, Wayne be­lieved he was in­vin­ci­ble. Be­cause of this mis­placed con­fi­dence, he de­layed his an­nual PSA blood test. He had tested four years be­fore, and passed with fly­ing colours; he was gob­s­macked when his PSA and fol­low-up showed prostate can­cer.

For Marc Curlewis, who got his tes­tic­u­lar can­cer di­ag­no­sis days be­fore turn­ing 30, his re­sponse was dis­be­lief. His surgery – in­clud­ing the re­moval of a testicle – hap­pened so quickly, he was forced to cope with his di­ag­no­sis at light speed. But seven years later, he’s can­cer-free, mar­ried, and look­ing for­ward to hav­ing kids.

IG­NOR­ING SYMP­TOMS: IT’S WHAT GUYS DO

Gaut­eng urol­o­gist Dr Bradley Wood says men are no­to­ri­ous for ig­nor­ing classic can­cer symp­toms – be­cause they’re in de­nial, or ig­no­rant, or scared, or just pre­oc­cu­pied with other stuff. Stats sug­gest that guys will ig­nore a lump or a swollen testicle for two months or more be­fore see­ing a doc­tor. This de­lay may al­low a fast-grow­ing ma­lig­nancy such as tes­tic­u­lar can­cer to spread to other or­gans, mak­ing it tough or even im­pos­si­ble to treat.

Brett Simp­son was an avid surfer and out­doors­man when he dis­cov­ered a le­sion on his lower lip. Mis­di­ag­nos­ing it as a cold sore or fever blis­ter, Brett let it fes­ter for months. When it be­came painful to eat, Brett’s girl­friend in­sisted he see a doc, who di­ag­nosed an ag­gres­sive squa­mous cell car­ci­noma (SCC), a kind of skin can­cer. Within 48 hours, Brett un­der­went surgery to re­move part of his lip.

Be­cause of the de­lay, the can­cer had spread to Brett’s lymph nodes, and he needed in­va­sive surgery and ra­di­a­tion. He took months to re­cover; but 10 years later, he’s alive, and now coaches oth­ers who have can­cer.

Brett’s can­cer ‘trans­formed’ him, he ex­plains. No longer ‘a cow­boy’ with his health, he pri­ori­tises his phys­i­cal and spir­i­tual well-be­ing, do­ing yoga, med­i­ta­tion, and long-dis­tance run­ning. He’s com­pleted mul­ti­ple Com­rades, along with the Puf­fer and an Iron­man. He still surfs and kite­boards – but these days, he’s vig­i­lant about sun pro­tec­tion.

Along with ig­nor­ing can­cer symp­toms, many guys don’t do self-checks – or take ad­van­tage of rou­tine screen­ing, which is read­ily avail­able through their doc­tor or clinic, and some­times free, through CANSA.

For some can­cers (col­orec­tal and prostate, for ex­am­ple), when you ex­pe­ri­ence symp­toms such as pain or uri­nary prob­lems, the can­cer may al­ready be ad­vanced and have spread to other or­gans. Rou­tine screen­ing means you spot a can­cer be­fore symp­toms oc­cur; and most im­por­tantly, you can treat it be­fore it en­larges or spreads.

WHY DO SOUTH AFRICAN MEN GET THE CAN­CERS THEY DO?

South Africa has the sec­ond-high­est rate of oc­cur­rence of skin can­cer in the world, af­ter Aus­tralia. Cape Town der­ma­tol­o­gist Dr Dag­mar Whi­taker ex­plains that SA’s sky-high lev­els are be­cause of ex­cep­tional UV con­cen­tra­tions in the south­ern hemi­sphere; and

be­cause South Africans spend so much time out­doors, of­ten un­pro­tected.

Skin can­cer is rou­tinely traced back to re­peated child­hood ex­po­sure, which then con­tin­ues through­out adult life. As Dr Whi­taker ex­plains, the im­mune sys­tem can deal with er­rant cells for years; but even­tu­ally it weak­ens, and can­cer grows. And while light skin is more prone to can­cer, those with darker skin are at risk too.

Col­orec­tal and prostate can­cer risk is associated with both life­style and ge­netic fac­tors. Race plays a role too: both white and coloured men have higher rates than black men. But both can­cers are associated with be­ing over­weight, lack of ex­er­cise, high red-meat con­sump­tion, and veg­gie-poor di­ets. Tra­di­tional African di­ets that are high in fi­bre are thought to be pro­tec­tive.

Red meat, and pro­cessed meats such as boere­wors, are in­trin­sic to South African braai cul­ture. The first time I heard at a guys-only braai that ‘chicken is a veg­etable’, I laughed – it’s not so funny now, given South African men’s can­cer stats.

SA also has one of the high­est in­ci­dences in the world of lung can­cer. UCT pul­mo­nolo­gist Dr Greg Symons ex­plains that this is not just be­cause of smok­ing, though that is the over­whelm­ing rea­son. Other con­trib­u­tors are il­le­gal drug use (in­clud­ing dagga and other in­halants); air pol­lu­tion both out­side and in the home, where the use of heat­ing and cook­ing fu­els to­gether with in­ad­e­quate ven­ti­la­tion is wide­spread; and work­place and in­dus­trial con­tam­i­na­tion, in min­ing and other in­dus­tries.

SELF- CHECKS & SCREEN­ING

When it comes to our most com­mon can­cers, there are sev­eral self-tests and rou­tine screen­ings you can em­ploy for early de­tec­tion.

Skin check self-test. Start­ing at pu­berty, check your skin monthly for anom­alies. Get to a doc­tor if you spot any sores that don’t heal; new or ex­pand­ing moles or dark spots that don’t go away; or any mole that starts itch­ing, bleed­ing or show­ing any sen­sa­tion.

The moles don’t need to be big to be dan­ger­ous. As Dr Whi­taker ex­plains, a mole is harm­less; but a melanoma only two mil­lime­tres thick will al­most cer­tainly kill you.

Tes­tic­u­lar can­cer screen­ing self-test. Men, es­pe­cially young men, should check their tes­ti­cles monthly, dur­ing or af­ter a warm bath or shower. Cup each testicle with a hand and roll it be­tween thumb and fin­gers, feel­ing for lumps, ir­reg­u­lar­i­ties or changes in size. Be­come fa­mil­iar with your balls, in­clud­ing the sper­matic cord and epi­didymis – the tube-like struc­tures that con­nect to the back of each testicle. CANSA pro­vides de­tailed info on how to self-test (www.cansa.org.za)

Prostate screen­ing. Men over 50 – or, if at high risk, over 35 – should con­sider be­ing screened an­nu­ally for prostate can­cer by means of a Prostate Spe­cific

Anti­gen (PSA) blood test. PSA (a pro­tein) level is rou­tinely higher than nor­mal in prostate can­cer and other in­flam­ma­tory prostate con­di­tions. In ad­di­tion to a PSA test, get a Digital Rec­tal Exam (DRE). Dr Wood says it’s im­por­tant to get both tests, be­cause the PSA test fails to de­tect the most ag­gres­sive kind of prostate can­cer – about 5% of cases.

Col­orec­tal can­cer screen­ing. At age 50 and an­nu­ally there­after, get a fae­cal oc­cult blood test. This lab test is non-in­va­sive, and ex­am­ines a smear of fae­ces for blood that may sug­gest can­cer or other prob­lems. Your doc­tor, clinic or CANSA will of­fer it.

At age 50, or 10 years be­fore the age a first-de­gree rel­a­tive was di­ag­nosed with col­orec­tal can­cer, and ev­ery 10 years there­after, get a colonoscopy. This is a day pro­ce­dure in which a gas­troen­terol­o­gist ex­am­ines the colon with a scope for polyps, which he can re­move for anal­y­sis and can­cer prevention.

KNOW YOUR BODY; AND CHECK IN WITH IT REG­U­LARLY

The main thing is to know your body, and see your doc­tor as soon as some­thing dif­fer­ent or ab­nor­mal appears. This goes for your skin, balls and pe­nis, fa­tigue lev­els, weight, bowel and uri­na­tion habits, and lung func­tion. Be aware. Be cu­ri­ous. Check any­thing ab­nor­mal with a doc­tor.

Brett Simp­son says his can­cer di­ag­no­sis has made him more aware of his body. When he sees some­thing sus­pi­cious, he waits no more than five days be­fore he goes to the doc­tor, on an emer­gency ba­sis, to get it checked. While he’s had some false scares, he’s also nipped an­other case of skin can­cer in the bud.

RE­DUC­ING YOUR CAN­CER RISK – THE BASICS

Avoid the sun. Wear sun-pro­tec­tive cloth­ing on arms and legs and a brimmed hat on your head – that’s the best pro­tec­tion. Use sun­screen of at least SPF 50+ on ex­posed skin, with full UVA pro­tec­tion, and don’t scrimp. Reap­ply at least ev­ery five hours; more of­ten, if you sweat or get wet.

Don’t smoke. Smok­ing is linked with higher risk of many can­cers – not just of the lungs, but mouth, throat, blad­der and pan­cre­atic can­cer too. Ven­ti­late ad­e­quately when us­ing cook­ing or heat­ing fuel. Avoid ex­po­sure to in­dus­trial pol­lu­tants, and use ad­e­quate pro­tec­tive equip­ment. Dr Symons says that de­spite man­u­fac­tur­ers’ claims, there is no re­li­able ev­i­dence that e-cig­a­rettes or other nico­tine in­halants are safer than con­ven­tional cig­a­rettes; it will take years to de­ter­mine their safety. Ex­er­cise reg­u­larly and main­tain a healthy weight. In­ter­nal can­cers such as col­orec­tal can­cer and prostate

can­cer are par­tic­u­larly associated with ab­dom­i­nal obe­sity. Dr Wood has noted this as­so­ci­a­tion in his prac­tice – he sees more can­cers in over­weight men who don’t ex­er­cise than in thin, fit guys. Eat a healthy diet, and stock up on whole grains and

plants, in­clud­ing whole fruits and veg. It’s thought that fruits and veg­gies con­tain im­por­tant nu­tri­ents and fi­bre that may pre­vent or slow the growth of can­cers. Me­gan Kluyts, con­sult­ing di­eti­cian for CANSA, rec­om­mends that you aim to con­sume at least five serv­ings of whole fruit and veg­eta­bles per day. Re­duce the amount of red meat and pro­cessed meat

you eat. Both are di­rectly associated with a higher risk of col­orec­tal can­cer. Avoid charred meat, and meat cooked at high tem­per­a­tures.

Avoid or limit al­co­hol. The In­ter­na­tional Agency for Re­search on Can­cer (IARC) has la­belled al­co­hol a car­cino­gen. Any al­co­hol, re­gard­less of type, in­creases your risk of can­cer, in­clud­ing liver, col­orec­tal, mouth, throat, stomach and oe­sophageal can­cer. Pro­fes­sor Michael Herbst of CANSA points out that although many con­sider red wine healthy be­cause of its (wildly touted) heart benefits, they are un­aware of its link to can­cer.

Age. For most can­cers, risk in­creases with age. While you can’t change your age, you can get reg­u­lar screen­ings or do self-checks, es­pe­cially as you get older.

Fam­ily his­tory of can­cer. Again, you can’t change the facts – but you can be more vig­i­lant. Your risk of get­ting can­cer in­creases if a fam­ily mem­ber (es­pe­cially a first-de­gree fam­ily mem­ber) has it. In the case of col­orec­tal can­cer, one close fam­ily mem­ber with the dis­ease more than doubles your risk; two fam­ily mem­bers more than quadru­ple your risk.

Sim­i­larly, men have an in­creased risk of prostate can­cer if they have a close rel­a­tive with prostate or breast can­cer. Wayne Herwitch got the PSA test he’d been put­ting off af­ter his sis­ter was di­ag­nosed with in­op­er­a­ble neck can­cer.

Bot­tom line? Share your health his­tory with fam­ily mem­bers, and don’t be shy to ask about theirs.

BE­ING GOOD ISN’T ENOUGH

Lucy Balona re­it­er­ates that vir­tu­ous liv­ing and elim­i­nat­ing life­style risks can re­duce can­cer risk – but not elim­i­nate it. “It’s es­sen­tial that men go for rou­tine screen­ing and do reg­u­lar self-checks,” she says, so that they can catch a can­cer early. Once it grows or metas­ta­sizes, can­cer is more dif­fi­cult to treat or con­tain, if not im­pos­si­ble.

Moses, Mark, Wayne, Marc and Brett are all men who went for screen­ing or took ac­tion when they saw signs of some­thing amiss. And that’s why they’re still alive to tell you about the benefits of know­ing your body, get­ting screened, and be­ing in the driver’s seat when it comes to your health.

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